Bleeding Diathesis

What Is It, Causes, Symptoms, and More

Author: Alyssa Haag

Editors: Ahaana Singh, Lisa Miklush, PhD, RN, CNS

Illustrator: Abbey Richard

Copyeditor: Joy Mapes

What is bleeding diathesis?

Bleeding diathesis refers to an increased susceptibility to bleeding or bruising. It can occur as a result of a wide variety of underlying disorders, most of which typically affect the clotting process.

Clotting, or coagulation, is a normal, multistep process that creates a clot, or a clump of semisolid blood, to prevent excessive bleeding when a blood vessel is injured. Clotting involves many different proteins, coagulation factors, and platelets. If one component of the clotting system is limited, the entire process may be affected.

What are the two main causes of bleeding diathesis?

Causes of bleeding diathesis can be classified into two types: acquired causes, which can develop throughout one’s lifetime, or congenital causes, which are present at birth.  

Acquired causes include vascular problems, low platelet counts, vitamin K deficiency, increased platelet destruction, kidney failure, liver disease, anticoagulant therapy, and an acquired clotting factor antibody. Vascular problems refer to issues with the blood vessels, which can lead to increased bleeding. Platelets and vitamin K play important roles in the coagulation process, and a deficiency of either can impair clotting. Because platelets are key to coagulation, disorders that result in increased destruction of platelets -- such as autoimmune thrombocytopenia (ITP), systemic lupus erythematosus, disseminated intravascular coagulation (DIC), thrombotic thrombocytopenic purpura (TTP), and hypersplenism -- are risk factors for bleeding diathesis. Similarly, chronic kidney disease may undermine platelet functioning which can subsequently hinder clotting. Regarding liver disease, the liver is responsible for crea†ting specific clotting proteins, and liver disease can decrease production of these proteins. Anticoagulant medications, such as heparin and warfarin, which are often used to reduce the risk of heart attacks or strokes, intentionally weaken the blood’s ability to clot. Finally, an acquired clotting antibody occurs when the body’s immune system attacks the clotting proteins, resulting in low levels of the specific clotting protein and reduced coagulation. 

On the other hand, congenital disorders that may cause bleeding diathesis include Bernard-Soulier syndrome, Glanzmann thrombasthenia, Ehlers-Danlos syndrome, and DiGeorge syndrome. Impaired wound healing is a common occurrence in both Bernard-Soulier syndrome and Glannzman thrombasthenia. Meanwhile, Ehlers-Danlos syndrome, which affects the connective tissue and underlying vessels, typically causes the individual to have very thin skin, increasing the likelihood of blood vessel rupture and bruising. DiGeorge syndrome is a disorder that typically results in developmental delays, frequent infections, heart problems, and cleft palate, but it may also affect the individual’s ability to clot. 

Some congenital causes of bleeding diathesis may also be inherited, or genetically passed down from parents to their children. These causes include von Willebrand Disease and hemophilia, both of which are coagulation disorders. Von Willebrand Disease is the most common inherited bleeding disorder, and it is characterized by significantly low levels of the von Willebrand factor, which is a protein that typically assists in the clotting process. Meanwhile, hemophilia is characterized by a lack of a certain clotting factor, which results in excessive bleeding. 

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How can a physician determine what is causing a bleeding disorder?

Due to its many potential causes, determining why an individual is experiencing bleeding diathesis may be quite difficult. Regardless, diagnosis usually begins with taking a thorough personal and family medical history, especially discussing the individual's history of bleeding and whether family members have experienced similar bleeding. A physical examination generally follows. Further laboratory testing is often pursued and may include a full blood workup. Typical initial screening tests include a complete blood count (CBC), an activated partial thromboplastin time (aPTT), and a prothrombin time (PT). A CBC looks for abnormalities in the levels of various blood components, such as red blood cells, white blood cells, and platelets. Meanwhile, an aPTT and a PT are used to test the blood clotting ability of an individual. Other more specific testing includes tests to look for clotting factor deficiencies, such as Factor VIII deficiency (as seen in Hemophilia A), and tests to look for the von Willebrand antigen. Genetic testing can also be performed in order to examine the genes affected by various bleeding disorders and identify the potential cause. Due to the breadth of diagnostic tests, diagnosis of the specific underlying bleeding disorder may take time. 

What are the most important facts to know about bleeding diathesis?

Bleeding diathesis refers to the increased tendency to bleed or bruise. Bleeding diathesis may result from acquired or congenital causes, most of which result in an impaired clotting process. Diagnostic testing begins with a thorough personal and family history and is typically followed by a wide array of laboratory tests. 

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Related links

Von Willebrand disease
Coagulation (secondary hemostasis)
Bernard-Soulier syndrome
Coagulation disorders: Pathology review

Resources for research and reference

Bashawri, L., & Ahmed, M. (2007). The approach to a patient with a bleeding disorder: For the primary care physician. Journal of Family & Community Medicine, 14(2): 53-58.

Hecht, M. (2019, September 24). What to know about bleeding diathesis: Causes, symptoms, treatment. In Healthline. 

Lutz, J., Menke, J., Sollinger, D., Schinzel, H., & Thürmel, K. (2014). Haemostasis in chronic kidney disease. Nephrology Dialysis Transplantation: Official Publication of the European Dialysis and Transplant Association - European Renal Association, 29(1): 29-40. DOI: 10.1093/ndt/gft209

Mayo Clinic Staff. (2020, October 16). Ehlers-Danlos syndrome. In Mayo Clinic: Health information; Diseases & conditions A-Z.  

National Hemophilia Foundation. (n.d.). Hemophilia A. 

National Hemophilia Foundation. (n.d.). Von Willebrand Disease. 

Tapia, M., Sanchez, B., Taramona, C., & Kuriakose, P. (2011). Assessment of adult patients with a suspected bleeding diathesis in a tertiary care center. Blood, 118(21): 4659. DOI: 10.1182/blood.V118.21.4659.4659